Inflamm Bowel Dis

Older adults with IBD treated with TNF inhibitors face higher risk of anti-drug antibodies

September 25, 2025

Study details: A multicenter retrospective cohort study evaluated the incidence of anti-drug antibody (ADA) development in older adults (≥60 years) with inflammatory bowel disease (IBD) treated with tumor necrosis factor alpha inhibitors (TNFi), compared with adults aged 18 to 59 years (4:1 ratio). Kaplan-Meier and Cox regression analyses were used to compare ADA risk and assess the impact of proactive therapeutic drug monitoring (TDM) on ADA development.

Results: Older adults had a significantly higher risk of developing ADAs to TNFi than younger adults (adjusted hazard ratio [aHR], 2.20; 95% confidence interval [CI], 1.44–3.36). Proactive TDM was associated with a lower risk of ADA formation (aHR, 0.36; 95% CI, 0.25–0.52), suggesting a protective effect.

Clinical impact: These findings challenge the assumption that immunosenescence reduces immunogenicity in older adults. Instead, older IBD patients on TNFi are at increased risk for ADA development, which may compromise drug efficacy and increase likelihood of treatment failure. Proactive TDM may be particularly beneficial in this population to enable early detection of ADAs and guide timely therapeutic adjustments.

Source:

Frost S, et al. (2025, September 15). Inflamm Bowel Dis. Incidence of Anti-Drug Antibody Development in Older Adults with Inflammatory Bowel Disease Treated with Tumor Necrosis Factor Alpha Inhibitors: A Large Multicenter Cohort Study. https://pubmed.ncbi.nlm.nih.gov/40971840/